Feeling Dumb

[NeurologyHopeful]

I'm a Neurology intern currently in my 4th month of residency and I still dont feel entirely comfortable being an intern. I've completed an ICU month, Ambulatory Clinic, GI consults, and currently on an Infectious Disease rotation.I just feel incompetent. I came into residency thinking that Neurology all day everyday would keep me happy, and that the prelim year wouldnt be bad. Dont get me wrong I get my work done and put all my effort into my patients/learning, but sometimes I feel inferior compared to the internal medicine residents who always seem to know more than me. I feel that a medical student would know more than me. None of my evaluations or attendings reflect incompetency. They all say general "hard worker" "gets along with team well" type things. Yet I feel incompetent. I'm still having to look up things and when I dont know my information on rounds i get flustered and just feel like I shouldn' be here. I have noticed that the attendings give slack to rotators, but is this feeling of not knowing normal? Does it get better? Any suggestions?

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[Trogghunter]

I'm an internal med intern and I feel borderline incompetent almost daily. The fund of knowledge in IM is so overwhelmingly vast that it's impossible to have a good grasp of it within even a year. Sounds like you're doing well otherwise and are at an appropriate level in your training. Keep your chin up, don't get all.....neurotic.

 

[QofQuimica]

Are you reading regularly? Even if you just read for 15-20 min per day about one of your current patients, that will add up over time and help you build up a fund of knowledge. You also should find out whether you have to take the in-service exam, and if so, get a prep book for it and read that too. Even if you don't have to take the in-service this year, it's not a bad idea to go through an IM review book. Make sure you look up anything you don't know.

 

[Perrotfish]

I'm a Neurology intern currently in my 4th month of residency and I still dont feel entirely comfortable being an intern. I've completed an ICU month, Ambulatory Clinic, GI consults, and currently on an Infectious Disease rotation.I just feel incompetent. I came into residency thinking that Neurology all day everyday would keep me happy, and that the prelim year wouldnt be bad. Dont get me wrong I get my work done and put all my effort into my patients/learning, but sometimes I feel inferior compared to the internal medicine residents who always seem to know more than me. I feel that a medical student would know more than me. None of my evaluations or attendings reflect incompetency. They all say general "hard worker" "gets along with team well" type things. Yet I feel incompetent. I'm still having to look up things and when I dont know my information on rounds i get flustered and just feel like I shouldn' be here. I have noticed that the attendings give slack to rotators, but is this feeling of not knowing normal? Does it get better? Any suggestions?

1) There is a reason attendings give slack to off service rotators. Remember that the IM interns likely spent half of their 4th year doing IM while you may not have touched the subject since 3rd year. Its not strange to be a little behind them. While you're at the same place in your career, they probably have four times as much training in their field as you.

2) More generally, almost every intern feels incompetent, and the ones who don't feel incompetent are generally the dangerous ones. More than any other time in your career this is when outside feedback is likely to be a better indicator of where you are then your perception of your abilities. If the attending says you're doing fine, you're doing fine.

3) Finally, if you can't shake the feeling that you really are a problem resident, make sure you use those feelings as motivation (read more, study more) rather than letting them paralyze and depress you. After all there's no escape hatch from this career, so all you can really do is to seek frequent feedback and study harder.

 

[Raryn]

1) There is a reason attendings give slack to off service rotators. Remember that the IM interns likely spent half of their 4th year doing IM while you may not have touched the subject since 3rd year. Its not strange to be a little behind them. While you're at the same place in your career, they probably have four times as much training in their field as you.

2) More generally, almost every intern feels incompetent, and the ones who don't feel incompetent are generally the dangerous ones. More than any other time in your career this is when outside feedback is likely to be a better indicator of where you are then your perception of your abilities. If the attending says you're doing fine, you're doing fine.

3) Finally, if you can't shake the feeling that you really are a problem resident, make sure you use those feelings as motivation (read more, study more) rather than letting them paralyze and depress you. After all there's no escape hatch from this career, so all you can really do is to seek frequent feedback and study harder.

1) A prelim is not an off service rotator. They are medicine interns that whole year. Do they get a bit of slack if they don't want to do procedures or such? Sure. But at least at my program they are otherwise treated the same as our categorical interns the vast majority of the year. Also, I don't know about other people, but my m4 year I did a grand total of two months of internal medicine, and one of them was the required ambulatory month all of my classmates did as well. I don't know anyone who spent 5-6 months of their m4 year doing IM.

2) Very true. All interns feel incompetent. I'd be scared of any intern who thought (s)he knew everything. There's a reason we have residency.

3)*nods*

 

[Perrotfish]

, I don't know about other people, but my m4 year I did a grand total of two months of internal medicine, and one of them was the required ambulatory month all of my classmates did as well. I don't know anyone who spent 5-6 months of their m4 year doing IM*

Really? I'm including subspecialties/ICU/ED, not just ward. My MS4 year in Peds I did 2 sub-Is, 1 NICU month, a subspecialty month (IM), and a Peds ED month. Most of my peers did something comparable. I figured IM would be similar.

What did you rotate in instead? Surgery? Radiology?

 

[Raryn]

Really? I'm including subspecialties/ICU/ED, not just ward. My MS4 year in Peds I did 2 sub-Is, 1 NICU month, a subspecialty month (IM), and a Peds ED month. Most of my peers did something comparable. I figured IM would be similar.

What did you rotate in instead? Surgery? Radiology?

Most US MD graduates I knew applying IM (and my friends applying peds too) did one subi at the beginning of the year. Maybe an ICU month and/or a single subspecialty rotation. The rest of the time, I (and most of my classmates) did random rotations. For example, I did a rotation in blood banking. Did a month of health policy stuff. A few months of vacation. No IM really. I wouldn't really count my ED month (which was an EM rotation, not an IM one).

DOs and IMGs frequently do 2-3 subis, but the logic and culture there are a little different.

No one I knew who applied any specialty did more than 3 months in that specialty their fourth year. The school wouldn't even allow it if you wanted to. The purpose of fourth year is to get a little bit of a break while expanding your horizons for the last time before you specialize.

 

[evilbooyaa]

Most US MD graduates I knew applying IM (and my friends applying peds too) did one subi at the beginning of the year. Maybe an ICU month and/or a single subspecialty rotation. The rest of the time, I (and most of my classmates) did random rotations. For example, I did a rotation in blood banking. Did a month of health policy stuff. A few months of vacation. No IM really. I wouldn't really count my ED month (which was an EM rotation, not an IM one).

DOs and IMGs frequently do 2-3 subis, but the logic and culture there are a little different.

No one I knew who applied any specialty did more than 3 months in that specialty their fourth year. The school wouldn't even allow it if you wanted to. The purpose of fourth year is to get a little bit of a break while expanding your horizons for the last time before you specialize.

While this may be true for IM (although most IM applicants I know did their mandatory 4th year sub-I + 1-3 IM specialties + an ICU rotation during their 4th year), competitive specialties that necessiate away rotations can sometimes convince people to do 4 months in their specialty of interest. At least, that's what I'm doing.

I don't agree with the last sentence. Maybe for the second half of the year. The first half of 4th year for those doing away rotations is just as much work as 3rd year. It feels like it's not as bad because you're generally focused on doing rotations in what you want to do.

 

[Raryn]

While this may be true for IM (although most IM applicants I know did their mandatory 4th year sub-I + 1-3 IM specialties + an ICU rotation during their 4th year), competitive specialties that necessiate away rotations can sometimes convince people to do 4 months in their specialty of interest. At least, that's what I'm doing.

I don't agree with the last sentence. Maybe for the second half of the year. The first half of 4th year for those doing away rotations is just as much work as 3rd year. It feels like it's not as bad because you're generally focused on doing rotations in what you want to do.

*shrug* Maybe it's a local difference then. No one at my medical school did four fourth year rotations in their specialty of interest. It was explicitly not allowed by the deans. Not ortho. Not neurosurgery. No one. You had to request special permission to even do three (which was usually granted, but not always).

 

[evilbooyaa]

I will admit I am a special case. I'm burning a month of vacation to squeeze in a 4th one. Most people I know that are giong for Ortho/NSG/etc. are doing 3 (the max our school allows without burning vacation time).

 

[Siggy]

*shrug* Maybe it's a local difference then. No one at my medical school did four fourth year rotations in their specialty of interest. It was explicitly not allowed by the deans. Not ortho. Not neurosurgery. No one. You had to request special permission to even do three (which was usually granted, but not always).

It was possible at my school to do 4 months of EM, IM (including sub-specialty) or surgery, however that was because the mandatory EM month, IM sub-I, and surgical sub-I did not count against the limitations on electives.

 

[lockjaw]

Definitely must vary from school to school. At my school, there may have been limits on doing a specific rotation multiple times (I think the max was 3; this likely only came up with people doing multiple away rotations), however as long as you're doing different rotations within the same specialty, there were no limits. For instance, I did a pediatric sub-I, NICU, development/behavior, pedi pulmonary, and pedi neuro for a total of 5 pediatric rotations. Most people at my school did multiple rotations in the same specialty. We had an extra-long 4th year though (14 months), so there was still plenty of time to do other rotations outside of your specialty (I also did ophtho, ENT, IM sub-I, EM, and palliative care, among other things).

 

[mvenus929]

My school had a limit of 3 months on a specialty, but Peds and IM were considered special cases, in that you couldn't do three months of Peds ID, but you could do Peds ID, Peds Heme/Onc, Peds Endo, and NICU and all of them would count as different specialties. On the other hand, Ortho only allowed 3 months total, so you couldn't do a month of Peds Ortho, then a month of Hand, then a month of Sports, and then a month of Foot and Ankle--and that included any away rotations.

I did a ton of peds electives during fourth year because I didn't want to deal with adults, but most of them fell under different specialties. Under the peds department, I did PICU, Peds Endo, Camp, General Outpatient Peds and Peds ID (totaling 4.25 months). Then I also did 2 weeks of Teen Health (under OB/GYN), 2 weeks of Peds ortho (under Ortho), 2 weeks of child psychiatry (under psych), 2 weeks of Peds ED (under EM), and 2 weeks of peds in Costa Rica (under international medicine). So, I essentially did 7 months of peds. I also did 1 month of IM, an additional 2 weeks of adult ED, 4 weeks of medical Spanish, 2 weeks of business, and 2 weeks of an administrative job at my school.